Title/Country |
The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer: A randomized study/Denmark. |
Physiotherapy management of axillary web syndrome following breast cancer treatment: Discussing the use of soft tissue techniques/England. |
Axillary web syndrome following secondary breast-conserving surgery: a case report/China. |
Effects of a physical therapy program combined with manual lymphatic drainage on shoulder function, quality of life, lymphedema incidence, and pain in breast cancer patients with axillary web syndrome following axillary dissection/South Korea. |
Mean age (SD) |
Group A: MRM + RT = 49 years, MRM = 60 years, BCT = 54 years; Group B: MRM + RT= 51 years, MRM= 63 years, BCT= 54 years. |
47 years. |
39 years. |
PTMLD group = 46.6 years; PT group = 50.7 years. |
Number of participants |
139 |
1 |
1 |
48 |
Study design |
Randomized controlled clinical trial |
Case report |
Case report |
Randomized controlled clinical trial |
Participants' characteristics |
Patients with breast cancer who underwent unilateral surgery planned according to the Danish Breast Cancer Cooperative Group (DBCG) guidelines. Exclusion criteria: comorbidities that would affect the upper limbs prior to surgery. |
Patient who underwent left MRM and axillary dissection. On the 22nd day post-surgery, she developed severe headache and nausea associated with the development of tight and painful subcutaneous cords extending from the medial aspect of the inner arm into the cubital tunnel and the medial aspect of the left wrist, with progressive restriction of all shoulder movements. |
Patient diagnosed with breast cancer who underwent conservative surgery and sentinel lymph node biopsy. Seventeen days after the first surgery, a second procedure was needed for margin excision. Three days after the second surgery, the patient reported severe pain in the ipsilateral axilla, limitation on shoulder abduction, and axillary cords. |
Breast cancer patients who underwent surgery with pain and visible or palpable cords in the arm for at least four weeks. Exclusion criteria: lymphedema, thrombosis, skin infection and musculoskeletal disorders. |
Intervention |
Group intervention with shoulder mobilization exercise program, relaxation, strength training, venous pump therapy, and instruction on mobilization of the scar tissue. The patients were encouraged to perform the exercises on a regular basis at home. |
Patient instructions and a booklet with home-based exercises. Physiotherapy sessions including axillary cord stretching in abduction, self-mobilization, as well as slight circular mobilization of the shoulder and soft tissue mobilization of the chest wall. |
Aescuven (Cesra Arzneimittel GmbH & Co., Baden-Baden, Germany) was prescribed twice a day for one week, and the patient was instructed to perform shoulder exercises, including shoulder abduction, and cord massage twice a day for 30 minutes. |
PT group: exercise program consisting of stretching and strengthening exercises for upper limb tissue mobilization, scapular mobilization, and shoulder ROM exercises. Specifically for AWS: 1) soft tissue mobilization techniques and stretching for tight tissue cords; 2) shoulder abduction, elbow extension, and wrist supination and extension stretching exercises; 3) shoulder girdle mobilization; and 4) passive ROM exercises. PTMLD group: the same exercise program in addition to 30 minutes of manual lymphatic drainage for 1 week, with instructions to perform it at home themselves for the other 2-4 weeks of the program. |
Treatment duration |
Group A: 12 physiotherapy sessions of 60 minutes, twice a week. The treatment started between the sixth and eighth postoperative weeks. Group B: 12 sessions of 60 minutes each, twice a week, but they only started after the 26th postoperative week. The patients were evaluated 4 times during the first postoperative year (at weeks 7, 13, 26 and 56). |
Ten sessions over 26 days. |
Two weeks |
Both groups: three sessions a week for four weeks |
Results |
Significant improvement in shoulder function on the surgical side on group A compared to group B starting at the second assessment (6 weeks on treatment). At the fourth evaluation, both groups presented a significant improvement. The number decreased to 43 (31%) patients on the second follow-up, and to 21 (15%) on the third follow-up, 6 months after surgery. Complete remission in all cases in the follow-up after 1 year. |
Improvement in shoulder mobility and well-being, enabling the participant to resume her fulltime activities 26 days after the onset of cording. After the completion of the physiotherapy sessions, the participant was instructed to continue with the self-mobilization and exercises. |
Increased ROM from 90° to 170°, and resolution of pain. The tightness and numbness sensation on the arm was still present, but improved. The cords were no longer visible or palpable at the end of the treatment. |
No significant difference regarding visible cording between the groups. Improvement in pain and arm volume in the group that performed manual lymphatic drainage. Both groups showed improvements in quality of life, strength and shoulder function after the interventions. |